May 4, 2015

Practice Management Systems a Vital Component in the Transition to ICD-10

By Chris Bruns

Last December, the Healthcare Administrative Technology Association (HATA) conducted a survey on practice management system (PMS) vendors’ ICD-10 readiness.

Contrary to the notion that the holdup with ICD-10 testing lies with PMS, the survey showed that an overwhelming majority of practice management vendors are actually ready. Results indicated that 80 percent of the PMS vendors had completed their internal preparations, to include impact analysis, resource allocation, a development and deployment strategy, a communication plan, and all internal systems developed and tested.

A full 60 percent (at the time the survey was conducted) had both their testing strategy and client training plans in place. Results also showed that 80 percent of all the PMS vendors that responded have their ICD-10 services and software available to customers. 

HATA members are doing external testing whenever possible. However, members are reporting that payers are not communicating about their plans with PMS vendors. The PMS vendors that responded to the HATA survey clearly stated that they are in need of information from their carriers to better understand payer implementation plans, implementation schedules, mapping information, crosswalk information, and changes in processing.

There has been a great deal of concern about whether practice management vendors will have the capacity for dual coding and generation and submission of either ICD-9 or ICD-10 claims. Fully 100 percent of respondents indicated that their systems currently allow for dual coding. The jury is out, however, in terms of what will happen when payers begin receiving both ICD-9 and ICD-10 claims. How will those payer adjudication systems handle this beginning on Oct. 1, 2015? The rules are still a bit unclear as to dual coding, so many entities are uncertain if they will continue or if they will cap their dual coding at the three-year timeline.

One of the overriding concerns from HATA members is the potential gridlock at the various points of failure. While there are so many organizations that must be aligned for this change to be successful, one thing is certain: providers, practice management vendors, clearinghouses, billing services, and payers must all commit to a full assessment of the risk areas present that would lead to problems post-Oct. 1, 2015. They must commit to full end-to-end testing when and wherever possible. HATA believes the end-to-end testing begins with the patient visit, and thus the provider.

The reality is that we don’t know what we don’t know – and with good planning, as you’ve likely heard before, providers should be ready with either three months of operating reserves or a new line of credit.  This could hold true as well for billing companies that are paid based upon their provider client receipts. 

About the Author

Chris Bruns, President of HATA. Chris is the product manager for MedInformatix, Inc., where he is leading the rollout of their Meaningful Use Stage 2 Certified Complete EHR. Before that, he was a partner in both the Professional Billing Services Group and the Professional Software Services Group in South Florida. Chris graduated from Virginia Polytechnic Institute and State University with a B.S. in electrical engineering. 

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